Bill Text: CA AB2244 | 2017-2018 | Regular Session | Introduced
Bill Title: Developmental services: regional centers: provider rates.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2018-05-25 - In committee: Held under submission. [AB2244 Detail]
Download: California-2017-AB2244-Introduced.html
CALIFORNIA LEGISLATURE—
2017–2018 REGULAR SESSION
| Assembly Bill | No. 2244 |
| Introduced by Assembly Member Acosta (Principal coauthor: Senator Stone) |
February 13, 2018 |
An act to amend Sections 4648.4, 4681.5, 4681.6, 4684.55, 4689.8, and 4691.9 of, and to add Section 4671 to, the Welfare and Institutions Code, relating to developmental services.
LEGISLATIVE COUNSEL'S DIGEST
AB 2244, as introduced, Acosta.
Developmental services: regional centers: provider rates.
Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities. Existing law sets forth the department’s and a regional center’s authority to establish provider rates. Existing law prohibits a regional center from paying a greater rate to a provider of certain services or supports, as specified, or from approving a service level for a residential service provider that would result in an increase in state costs, unless the regional center demonstrates that the approval is necessary to protect the consumer’s health or safety and the department has granted prior written authorization or, in certain circumstances, unless the increase is required by a contract between the regional center and the vendor, as specified.
This bill would deem a request from a regional center for prior written authorization approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request, as specified. If the director determines that additional time is necessary, the bill would grant the department an additional 30 calendar days to act on the request. The bill would authorize additional extensions of time only upon agreement of all parties, as specified.
The bill would, for a request from a regional center for prior written authorization involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, as defined, require the department to notify the regional center of its decision to grant or deny the request
within 3 working days from receipt of the request. The bill would authorize the department to request additional information from a regional center under those circumstances, and would prescribe the procedure for making that request. If requested, once that information is provided to the department, the bill would require the department to make a decision to grant or deny the request within 3 working days.
The bill would also, for a request from a regional center for prior written authorization, require the department to provide receipt of those requests and the contact information of the department representative handling the request to the regional center. The bill would authorize the consumer or the regional center to request a meeting with the department representative handling the request, as prescribed.
The bill would require the department to provide an accounting annually to the Legislature with regard to regional
center requests for prior written authorization, as specified.
Existing law prohibits a regional center from negotiating a rate with new residential service providers, new supported living service providers, or other certain service providers, as specified, that is higher than the statewide or regional center’s median rate for the same service code and unit of service, whichever is lower.
This bill would make an exception to the above prohibition if the regional center demonstrates that the approval is necessary to protect an individual consumer’s health or safety and the department has granted prior written authorization. The bill would also make the 30-day and 3-day time frames described above applicable to these provisions.
Existing law requires the department to promulgate regulations for payment for community-based programs, including a procedure for
appealing rates. Existing law prohibits certain rate increases for residential service providers, but, commencing July 1, 2017, authorizes increases to those rates as necessary to adjust employee wages to meet the state minimum wage law.
This bill would, on or before July 1, 2019, require the department to adopt regulations to create a process to review requests from regional centers in order to resolve systemic issues with service provider rates that have the potential to create economic distress for service providers or disrupt services to consumers, including, but not limited to, local minimum wage ordinances. The bill would require the department to include in the review process regulations a requirement that the department render a decision on the requested review no later than 60 calendar days after receipt of the review request unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate
the request, as specified.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 4648.4 of the Welfare and Institutions Code is amended to read:4648.4.
(a) Notwithstanding any other(b) Notwithstanding any other provision of
law or regulation, except for subdivision (a), no a regional center may shall not pay any provider of the following services or supports a rate that is greater than the rate that is in effect on or after June 30, 2008, unless the increase is required by a contract between the regional center and the vendor that is in effect on June 30, 2008, or the regional center demonstrates that the approval is necessary to protect the an individual
consumer’s health or safety and the department has granted prior written authorization:
(1) Supported living services.
(2) Transportation, including travel reimbursement.
(3) Socialization training programs.
(4) Behavior intervention training.
(5) Community integration training programs.
(6) Community activities support services.
(7) Mobile day programs.
(8) Creative art programs.
(9) Supplemental day services program
supports.
(10) Adaptive skills trainers.
(11) Independent living specialists.
(c) (1) A request from a regional center for prior written authorization, as described in subdivision (b), shall be deemed approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination. If the director determines that additional time is necessary, the department shall be granted an additional 30 calendar days to act on the request. Additional extensions may be granted only if the
consumer, the regional center, and the department all agree to the additional extension.
(2) For a request from a regional center for prior written authorization, as described in subdivision (b), involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, the department shall notify the regional center of its decision to grant or deny the request within three working days from receipt of the request. If the department requires additional information from the regional center in order to reach a decision, the department may make a single request for that information within three working days of receipt of the regional center’s request. In that instance, once the department receives the requested information, the department shall have three working days to reach a decision. For
purposes of this paragraph, “imminent and serious threat to the health and safety of the individual consumer” shall include, but not be limited to, the following:
(A) Consumers who are currently placed in, or would otherwise be at risk of admission to, any of the following:
(i) The acute crisis center at Fairview Developmental Center or Sonoma Developmental Center.
(ii) An out-of-state placement.
(iii) An institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5.
(iv) A facility utilizing secure perimeters pursuant to Section 1531.15 of the
Health and Safety Code.
(B) Consumers who would otherwise be at risk of placement in a more restrictive or less integrated setting.
(d) Upon receipt of either an oral or written request from a regional center for prior written authorization, as described in subdivision (b), the department shall, within three working days of receipt of the request, send a written acknowledgment of receipt to the regional center that includes, at a minimum, the date of receipt of the request and the contact information of the department representative handling the request review. An email from the department shall satisfy this requirement.
(e) The consumer or the regional center may ask for a meeting with the department representative handling the review. If asked, the department shall grant the meeting request and hold the meeting
prior to its decision to grant or deny the waiver request. The department may fulfill this meeting requirement through telephone or other electronic means, if the regional center or consumer who requested the meeting has the necessary equipment to conduct the meeting electronically.
(f) The department shall annually provide an accounting of the age of each request that is received from the regional centers during the previous calendar year, as described in subdivision (b) and separated out by each individual regional center, to the relevant policy and fiscal committees of the Legislature. The department shall also make that accounting available on the department’s Internet Web site.
SEC. 2.
Section 4671 is added to the Welfare and Institutions Code, to read:4671.
On or before July 1, 2019, the department shall adopt regulations to establish a process to review requests from regional centers to resolve systemic issues with service provider rates that have the potential to create economic distress for service providers or disrupt services to consumers, including, but not limited to, local minimum wage ordinances. The department shall include in the review process regulations a requirement that the department render a decision on the requested review no later than 60 calendar days after receipt of the review request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination.SEC. 3.
Section 4681.5 of the Welfare and Institutions Code is amended to read:4681.5.
(a) (1) Notwithstanding any other law or regulation, a regional center shall not approve a service level for a residential service provider, as defined in Section 56002 of Title 17 of the California Code of Regulations, if the approval would result in an increase in state costs or the rate to be paid to the provider that is greater than the rate that is in effect on June 30, 2008, or, for residential service providers subject to subdivision (b), unless the regional center demonstrates to the department that the approval is necessary to protect(2) A request from a regional center for prior written authorization, as described in paragraph (1), shall be deemed approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination. If the director determines that additional time is necessary, the department shall be granted an additional 30 calendar days to act on the request. Additional extensions may be granted only if the consumer, the regional center, and the department all agree to the additional extension.
(3) For a request from a regional center for prior written authorization, as described in paragraph (1), involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, the department shall notify the regional center of its decision to grant or deny the request within three working days from receipt of the request. If the department requires additional information from the regional center in order to reach a decision, the department may make a single request for that information within three working days of receipt of the regional center’s request. In that instance, once the department receives the requested information, the department shall have three working days to reach a decision. For purposes of this paragraph, “imminent and serious threat to the health and safety of the individual consumer” shall include, but not be limited to, the following:
(A) Consumers who are currently placed in, or would otherwise be at risk of admission to, any of the following:
(i) The acute crisis center at Fairview Developmental Center or Sonoma Developmental Center.
(ii) An out-of-state placement.
(iii) An institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5.
(iv) A facility utilizing secure perimeters pursuant to Section 1531.15 of the Health and Safety Code.
(B) Consumers who would otherwise be at risk of placement in a more restrictive or less integrated setting.
(4) Upon
receipt of either an oral or written request from a regional center for prior written authorization, as described in paragraph (1), the department shall, within three working days of receipt of the request, send a written acknowledgment of receipt to the regional center that includes, at a minimum, the date of receipt of the request and the contact information of the department representative handling the request review. An email from the department shall satisfy this requirement.
(5) The consumer or the regional center may ask for a meeting with the department representative handling the review. If asked, the department shall grant the meeting request and hold the meeting prior to its decision to grant or deny the waiver request. The department may fulfill this meeting requirement through telephone or other electronic means, if the regional center or consumer who requested the meeting has the necessary equipment to conduct the meeting
electronically.
(6) The department shall annually provide an accounting of the age of each request that is received from the regional centers during the previous calendar year, as described in paragraph (1) and separated out by each individual regional center, to the relevant policy and fiscal committees of the Legislature. The department shall also make that accounting available on the department’s Internet Web site.
(b) Notwithstanding subdivision (a) or any other law or regulation, the department shall, effective July 1, 2016, establish a rate schedule for residential community care facilities vendored to provide services to a maximum of four persons with developmental disabilities.
(c) Community care facilities with rates established pursuant to subdivision (b) are subject to the
regulatory requirements contained in Subchapter 4 (commencing with Section 56001) of Chapter 3 of Division 2 of Title 17 of the California Code of Regulations.
(d) Rate changes made as a result of implementing the rate schedule established pursuant to subdivision (b) for community care facilities vendored to provide services to a maximum of four persons with developmental disabilities are not subject to the restrictions of subdivision (a) if the approved service level is not higher than the service level in effect at the time of the change.
(e) No later than February 1, 2017, regional centers shall report to the department on the number of residential community care facilities with rates established pursuant to subdivision (b). The report shall include, but not be limited to, both of the following:
(1) The number of
facilities vendored since July 1, 2016, by service level and vendored capacity.
(2) The number of facilities vendored prior to July 1, 2016, that have subsequently been approved for a new rate, by service level, vendored capacity, and prior vendored capacity, if applicable.
SEC. 4.
Section 4681.6 of the Welfare and Institutions Code is amended to read:4681.6.
(a) Notwithstanding any other law or regulation, commencing July 1, 2008:(1) A regional center shall not pay an existing residential service provider, for services where for which rates are determined through a negotiation between the regional center and the provider, a rate higher than the rate in effect on June 30, 2008, unless the increase is required by a contract between the regional center and the vendor that is in effect on June 30, 2008, or the regional center demonstrates that the approval is necessary to protect the
an individual consumer’s health or safety and the department has granted prior written authorization.
(2) A regional center shall not negotiate a rate with a new residential service provider, for services where for which rates are determined through a negotiation between the regional center and the provider, that is higher than the regional center’s median rate for the same service code and unit of service, or the statewide median rate for the same service code and unit of service, whichever is lower. lower, unless the regional center demonstrates that
the approval is necessary to protect an individual consumer’s health or safety and the department has granted prior written authorization. The unit of service designation shall conform with an existing regional center designation or, if none exists, a designation used to calculate the statewide median rate for the same service. The regional center shall annually certify to the department its median rate for each negotiated rate service code, by designated unit of service. This certification shall be subject to verification through the department’s biennial fiscal audit of the regional center.
(3) A request from a regional center for prior written authorization, as described in paragraph (1) or (2), shall be deemed approved by the department if the department does not act on the request within 30 calendar days of receipt of the request,
unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination. If the director determines that additional time is necessary, the department shall be granted an additional 30 calendar days to act on the request. Additional extensions may be granted only if the consumer, the regional center, and the department all agree to the additional extension.
(4) For a request from a regional center for prior written authorization, as described in paragraph (1) or (2), involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, the department shall notify the regional center of its decision to grant or deny the request within three working days from receipt of
the request. If the department requires additional information from the regional center in order to reach a decision, the department may make a single request for that information within three working days of receipt of the regional center’s request. In that instance, once the department receives the requested information, the department shall have three working days to reach a decision. For purposes of this paragraph, “imminent and serious threat to the health and safety of the individual consumer” shall include, but not be limited to, the following:
(A) Consumers who are currently placed in, or would otherwise be at risk of admission to, any of the following:
(i) The acute crisis center at Fairview Developmental Center or Sonoma Developmental Center.
(ii) An out-of-state placement.
(iii) An institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5.
(iv) A facility utilizing secure perimeters pursuant to Section 1531.15 of the Health and Safety Code.
(B) Consumers who would otherwise be at risk of placement in a more restrictive or less integrated setting.
(5) Upon receipt of either an oral or written request from a regional center for prior written authorization, as described in paragraph (1) or (2), the department shall, within three working days of receipt of the request, send a written acknowledgment of receipt to the regional center that includes, at a minimum, the date of receipt of the
request and the contact information of the department representative handling the request review. An email from the department shall satisfy this requirement.
(6) The consumer or the regional center may ask for a meeting with the department representative handling the review. If asked, the department shall grant the meeting request and hold the meeting prior to its decision to grant or deny the waiver request. The department may fulfill this meeting requirement through telephone or other electronic means, if the regional center or consumer who requested the meeting has the necessary equipment to conduct the meeting electronically.
(7) The department shall annually provide an accounting of the age of each request that is received from the regional centers during the previous calendar year, as described in paragraph (1) or (2) and separated out by each individual regional center, to
the relevant policy and fiscal committees of the Legislature. The department shall also make that accounting available on the department’s Internet Web site.
(b) Notwithstanding subdivision (a), commencing January 1, 2017, regional centers may negotiate a rate adjustment with residential service providers regarding rates that are otherwise restricted pursuant to subdivision (a), if the adjustment is necessary in order to pay employees no less than the minimum wage as established by Section 1182.12 of the Labor Code, as amended by Chapter 4 of the Statutes of 2016, and only for the purpose of adjusting payroll costs associated with the minimum wage increase. The rate adjustment shall be specific to the unit of service designation that is affected by the increased minimum wage, shall be specific to payroll costs associated with any increase necessary to adjust employee pay only to the extent necessary to bring pay into
compliance with the increased state minimum wage, and shall not be used as a general wage enhancement for employees paid above the minimum wage. Regional centers shall maintain documentation on the process to determine, and the rationale for granting, any rate adjustment associated with the minimum wage increase.
(c) Notwithstanding subdivision (a), commencing July 1, 2015, regional centers may negotiate a rate adjustment with residential service providers regarding rates that are otherwise restricted pursuant to subdivision (a), if the adjustment is necessary to implement Article 1.5 (commencing with Section 245) of Chapter 1 of Part 1 of Division 2 of the Labor Code, as added by Chapter 317 of the Statutes of 2014. The rate adjustment may be applied only if a minimum of 24 hours or three days of paid sick leave per year was not a benefit provided to employees as of June 30, 2015, and shall be specific to payroll costs associated with any
increase necessary to compensate an employee up to a maximum of 24 hours or three days of paid sick leave in each year of employment.
(d) For purposes of this section, “residential service provider” includes
an
Adult Residential Facilities
Facility for Persons with Special Health Care Needs, as described in Section 4684.50.
(e) This section shall not apply to those services for which rates are determined by the State Department of Health Care Services, or the State Department of Developmental Services, or are usual and customary.
SEC. 5.
Section 4684.55 of the Welfare and Institutions Code is amended to read:4684.55.
(a)(2) A request from a regional center for prior written authorization, as described in paragraph (1), shall be deemed approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination. If the director determines that additional time is necessary, the
department shall be granted an additional 30 calendar days to act on the request. Additional extensions may be granted only if the consumer, the regional center, and the department all agree to the additional extension.
(3) For a request from a regional center for prior written authorization, as described in paragraph (1), involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, the department shall notify the regional center of its decision to grant or deny the request within three working days from receipt of the request. If the department requires additional information from the regional center in order to reach a decision, the department may make a single request for that information within three working days of receipt of the regional center’s request. In that instance,
once the department receives the requested information, the department shall have three working days to reach a decision. For purposes of this paragraph, “imminent and serious threat to the health and safety of the individual consumer” shall include, but not be limited to, the following:
(A) Consumers who are currently placed in, or would otherwise be at risk of admission to, any of the following:
(i) The acute crisis center at Fairview Developmental Center or Sonoma Developmental Center.
(ii) An out-of-state placement.
(iii) An institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5.
(iv) A facility utilizing secure perimeters pursuant to Section 1531.15 of the Health and Safety Code.
(B) Consumers who would otherwise be at risk of placement in a more restrictive or less integrated setting.
(4) Upon receipt of either an oral or written request from a regional center for prior written authorization, as described in paragraph (1), the department shall, within three working days of receipt of the request, send a written acknowledgment of receipt to the regional center that includes, at a minimum, the date of receipt of the request and the contact information of the department representative handling the request review. An email from the department shall satisfy this requirement.
(5) The consumer or the regional center may ask for a
meeting with the department representative handling the review. If asked, the department shall grant the meeting request and hold the meeting prior to its decision to grant or deny the waiver request. The department may fulfill this meeting requirement through telephone or other electronic means, if the regional center or consumer who requested the meeting has the necessary equipment to conduct the meeting electronically.
(6) The department shall annually provide an accounting of the age of each request that is received from the regional centers during the previous calendar year, as described in paragraph (1) and separated out by each individual regional center, to the relevant policy and fiscal committees of the Legislature. The department shall also make that accounting available on the department’s Internet Web site.
(b) The payment rate for ARFPSHN
services shall be negotiated between the regional center and the ARFPSHN, and shall be paid by the regional center under the service code “Specialized Residential Facility (Habilitation).”
(c) The established rate for a full month of service shall be made by the regional center when a consumer is temporarily absent from the ARFPSHN 14 days or less per month. When the consumer’s temporary absence is due to the need for inpatient care in a health facility, as defined in subdivision (a), (b), or (c) of Section 1250 of the Health and Safety Code, the regional center shall continue to pay the established rate as long as no other consumer occupies the vacancy created by the consumer’s temporary absence, or until the individual health care plan team has determined that the consumer will not return to the facility. In all other cases, the established rate shall be prorated for a partial month of service by dividing the established rate by 30.44 then by
multiplying the quotient by the number of days the consumer resided in the facility.
SEC. 6.
Section 4689.8 of the Welfare and Institutions Code is amended to read:4689.8.
(a) Notwithstanding any other law or regulation, commencing July 1, 2008:(a)No
(1) A regional center may
shall not pay an existing supported living service provider, for services where for which
rates are determined through a negotiation between the regional center and the provider, a rate higher than the rate in effect on June 30, 2008, unless the increase is required by a contract between the regional center and the vendor that is in effect on June 30, 2008, or the regional center demonstrates that the approval is necessary to protect the an individual consumer’s health or safety and the department has granted prior written authorization.
(b)No
(2) A regional center may
shall not negotiate a rate with a new supported living service provider, for services where
for which rates are determined through a negotiation between the regional center and the provider, that is higher than the regional center’s median rate for the same service code and unit of service, or the statewide median rate for the same service code and unit of service, whichever is lower. lower, unless the regional center demonstrates that the approval is necessary to protect an individual consumer’s health or safety and the department has granted prior written authorization. The unit of service designation shall conform with an existing regional center designation or, if none exists, a designation used to calculate the statewide median rate for the same service. The regional center shall annually certify to the State Department of Developmental Services its median rate for
each negotiated rate service code, by designated unit of service. This certification shall be subject to verification through the department’s biennial fiscal audit of the regional center.
(c)
(3) Notwithstanding any other law or regulation, commencing July 1, 2016, and to the extent funds are appropriated in the annual Budget Act for this purpose, the rates in effect on June 30, 2016, for supported living services, as defined in Subchapter 19 (commencing with Section 58600) of Chapter 3 of Division 2 of Title 17 of the California Code of Regulations, shall be
increased by 5 percent. The increase shall be applied as a percentage, and the percentage shall be the same for all providers.
(b) (1) A request from a regional center for prior written authorization, as described in subdivision (a), shall be deemed approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination. If the director determines that additional time is necessary, the department shall be granted an additional 30 calendar days to act on the request. Additional extensions may be granted only if the consumer, the regional center, and the department all agree to the additional
extension.
(2) For a request from a regional center for prior written authorization, as described in subdivision (a), involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, the department shall notify the regional center of its decision to grant or deny the request within three working days from receipt of the request. If the department requires additional information from the regional center in order to reach a decision, the department may make a single request for that information within three working days of receipt of the regional center’s request. In that instance, once the department receives the requested information, the department shall have three working days to reach a decision. For purposes of this paragraph, “imminent and serious threat to the health and safety of
the individual consumer” shall include, but not be limited to, the following:
(A) Consumers who are currently placed in, or would otherwise be at risk of admission to, any of the following:
(i) The acute crisis center at Fairview Developmental Center or Sonoma Developmental Center.
(ii) An out-of-state placement.
(iii) An institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5.
(iv) A facility utilizing secure perimeters pursuant to Section 1531.15 of the Health and Safety Code.
(B) Consumers who would otherwise be at risk of placement in a more restrictive or less integrated setting.
(3) Upon receipt of either an oral or written request from a regional center for prior written authorization, as described in subdivision (a), the department shall, within three working days of receipt of the request, send a written acknowledgment of receipt to the regional center that includes, at a minimum, the date of receipt of the request and the contact information of the department representative handling the request review. An email from the department shall satisfy this requirement.
(4) The consumer or the regional center may ask for a meeting with the department representative handling the review. If asked, the department shall grant the meeting request and hold the meeting prior to its decision to grant or deny the waiver request. The department may
fulfill this meeting requirement through telephone or other electronic means, if the regional center or consumer who requested the meeting has the necessary equipment to conduct the meeting electronically.
(5) The department shall annually provide an accounting of the age of each request that is received from the regional centers during the previous calendar year, as described in subdivision (a) and separated out by each individual regional center, to the relevant policy and fiscal committees of the Legislature. The department shall also make that accounting available on the department’s Internet Web site.
SEC. 7.
Section 4691.9 of the Welfare and Institutions Code is amended to read:4691.9.
(a) (1) Notwithstanding any other law or regulation, commencing July 1, 2008:(1)
(A) A regional center shall not pay an existing service provider, for services where
for which rates are determined through a negotiation between the regional center and the provider, a rate higher than the rate in effect on June 30, 2008, unless the increase is required by a contract between the regional center and the vendor that is in effect on June 30, 2008, or the regional center demonstrates that the approval is necessary to protect the an individual consumer’s health or safety and the department has granted prior written authorization.
(2)
(B) A regional center shall not negotiate a rate with a new service provider, for services where
for which rates are determined through a negotiation between the regional center and the provider, that is higher than the regional center’s median rate for the same service code and unit of service, or the statewide median rate for the same service code and unit of service, whichever is lower. lower, unless the regional center demonstrates that the approval is necessary to protect an individual consumer’s health or safety and the department has granted prior written authorization. The unit of service designation shall conform with an existing regional center designation or, if none exists, a designation used to calculate the statewide median rate for the same service. The regional center shall annually certify to the State Department of Developmental Services its median rate for
each negotiated rate service code, by designated unit of service. This certification shall be subject to verification through the department’s biennial fiscal audit of the regional center.
(2) A request from a regional center for prior written authorization, as described in subparagraph (A) or (B) of paragraph (1), shall be deemed approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request and notifies the regional center of that determination. If the director determines that additional time is necessary, the department shall be granted an additional 30 calendar days to act on the request. Additional extensions may be granted only if the consumer, the
regional center, and the department all agree to the additional extension.
(3) For a request from a regional center for prior written authorization, as described in subparagraph (A) or (B) of paragraph (1), involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, the department shall notify the regional center of its decision to grant or deny the request within three working days from receipt of the request. If the department requires additional information from the regional center in order to reach a decision, the department may make a single request for that information within three working days of receipt of the regional center’s request. In that instance, once the department receives the requested information, the department shall have three working days to reach a decision.
For purposes of this paragraph, “imminent and serious threat to the health and safety of the individual consumer” shall include, but not be limited to, the following:
(A) Consumers who are currently placed in, or would otherwise be at risk of admission to, any of the following:
(i) The acute crisis center at Fairview Developmental Center or Sonoma Developmental Center.
(ii) An out-of-state placement.
(iii) An institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5.
(iv) A facility utilizing secure perimeters pursuant to Section 1531.15 of
the Health and Safety Code.
(B) Consumers who would otherwise be at risk of placement in a more restrictive or less integrated setting.
(4) Upon receipt of either an oral or written request from a regional center for prior written authorization, as described in subparagraph (A) or (B) of paragraph (1), the department shall, within three working days of receipt of the request, send a written acknowledgment of receipt to the regional center that includes, at a minimum, the date of receipt of the request and the contact information of the department representative handling the request review. An email from the department shall satisfy this requirement.
(5) The consumer or the regional center may ask for a meeting with the department representative handling the review. If asked, the department shall grant the meeting
request and hold the meeting prior to its decision to grant or deny the waiver request. The department may fulfill this meeting requirement through telephone or other electronic means, if the regional center or consumer who requested the meeting has the necessary equipment to conduct the meeting electronically.
(6) The department shall annually provide an accounting of the age of each request that is received from the regional centers during the previous calendar year, as described in subparagraph (A) or (B) of paragraph (1) and separated out by each individual regional center, to the relevant policy and fiscal committees of the Legislature. The department shall also make that accounting available on the department’s Internet Web site.
(b) Notwithstanding subdivision (a), commencing January 1, 2017, regional centers may negotiate a rate adjustment with
providers regarding rates if the adjustment is necessary in order to pay employees no less than the minimum wage as established by Section 1182.12 of the Labor Code, as amended by Chapter 4 of the Statutes of 2016, and only for the purpose of adjusting payroll costs associated with the minimum wage increase. The rate adjustment shall be specific to the unit of service designation that is affected by the increased minimum wage, shall be specific to payroll costs associated with any increase necessary to adjust employee pay only to the extent necessary to bring pay into compliance with the increased state minimum wage, and shall not be used as a general wage enhancement for employees paid above the increased minimum wage. Regional centers shall maintain documentation on the process to determine, and the rationale for granting, any rate adjustment associated with the minimum wage increase.
(c) Notwithstanding any other law or regulation,
commencing January 1, 2015, rates for personal assistance and supported living services in effect on December 31, 2014, shall be increased by 5.82 percent, subject to funds specifically appropriated for this increase for costs due to changes in federal regulations implementing the federal Fair Labor Standards Act of 1938 (29 U.S.C. Sec. 201 et seq.). The increase shall be applied as a percentage, and the percentage shall be the same for all applicable providers. As used in this subdivision, both of the following definitions shall apply:
(1) “Personal assistance” is limited only to those services provided by vendors classified by the regional center as personal assistance providers, pursuant to the miscellaneous services provisions contained in Title 17 of the California Code of Regulations.
(2) “Supported living services” are limited only to those services defined as supported
living services in Title 17 of the California Code of Regulations.
(d) Notwithstanding subdivision (a), commencing July 1, 2015, regional centers may negotiate a rate adjustment with existing service providers for services for which rates are determined through negotiation between the regional center and the provider, if the adjustment is necessary to implement Article 1.5 (commencing with Section 245) of Chapter 1 of Part 1 of Division 2 of the Labor Code, as added by Chapter 317 of the Statutes of 2014. The rate adjustment may be applied only if a minimum of 24 hours or three days of paid sick leave per year was not a benefit provided to employees as of June 30, 2015, and shall be specific to payroll costs associated with any increase necessary to compensate an employee up to a maximum of 24 hours or three days of paid sick leave in each year of employment.
(e) Notwithstanding
any other law or regulation, commencing July 1, 2016, and to the extent funds are appropriated in the annual Budget Act for this purpose, rates for transportation services in effect on June 30, 2016, shall be increased by 5 percent. The increase shall be applied as a percentage to existing rates, and the percentage shall be the same for all applicable providers.
(f) This section shall not apply to those services for which rates are determined by the State Department of Health Care Services, or the State Department of Developmental Services, or are usual and customary.
